Ureter retrocaval reconstruction: case report and surgical description

Abstract

Introduction: Retrocaval ureter is a rare congenital anomaly resulting from abnormal embryonic development of the vena cava, with an estimated incidence of 1 in every 1,000 live births and higher prevalence in males. Diagnosis is made through exams such as retrograde pyelography, intravenous urography, magnetic resonance imaging, or computed tomography, which show characteristic alteration in the form of an inverted “J” or “S”. Treatment is indicated when there is significant pain, severe hydronephrosis, and recurrent urinary tract infections, with the surgery of choice being pyelopyelostomy, in which the ureter is transposed anteriorly to the vena cava. Case report: We report the case of a 34-year-old man, without comorbidities, who presented with recurrent and intense lower back pain radiating to the right iliac fossa since September 2021, without complaints of urge incontinence and dysuria. Diagnosis was made through contrast-enhanced computed tomography and scintigraphy, which showed the compressed right retrocaval ureter between the psoas muscle and the inferior vena cava, determining moderate ureterohydronephrosis upstream. The patient underwent videolaparoscopy for proximal ureteral reconstruction with Caprofyl 4.0, without complications, and was discharged on the second postoperative day. Discussion: Classic exams for diagnosis are retrograde pyelography and intravenous urography, but computed tomography and magnetic resonance imaging have been proposed as first-choice exams. Treatment is individualized, with clinical or surgical options. Laparoscopic surgery is the option of choice, and the videolaparoscopic technique is superior to open surgery, with advantages of retroperitoneal or transperitoneal approach depending on the surgeon's preference. Single-site laparoendoscopic surgery is a developing technique, but it may be associated with a lower need for analgesics and better aesthetic outcome. Conclusion: The treatment depends on the presence of repercussions in the patient. Laparoscopic surgical correction of retrocaval ureter has shown better results in several aspects when compared to open techniques, with transperitoneal or retroperitoneal approach depending on the surgeon's preferences.